The value of doing nothing
“Watchful waiting,” “expectant management,” and “active surveillance” are all terms for not treating a condition when it appears. It turns out this path is a good one for many men with prostate cancer. After all, treatment can cause incontinence and/or impotence while doing nothing in many cases does no harm.
According to the Wall Street Journal (Doctors Seek to Identify Which Patients Can Avoid Prostate-Cancer Treatments):
Watchful-waiting patients who end up needing treatment anyway haven’t compromised their care, the Journal of the National Cancer Institute reported this month. Researchers at Johns Hopkins Medical School studied 38 patients who needed surgery after about two years of watchful waiting, compared with 150 similar patients who opted for surgery right away. There was no difference in noncurable cancer between the two groups.
“Most individuals are not comfortable with monitoring because the physicians and the patients are worried about losing the window of opportunity for a cure,” says Ballantine Carter, professor of urology and oncology at Johns Hopkins. But if a careful selection process is used, “there is no reason for a man to rush into any treatment.”
Prostate cancer is the first big example of watchful waiting, because the cancer can be detected well before it causes serious harm. As diagnostic tests improve patients will be “diagnosed” with all sorts of maladies –including other forms of cancer– at such an early stage that they may never do any harm. If we treat everything aggressively, not only will the cure be worse than the disease but the cost will be higher, too.March 28, 2006